Financial advisor

Agent number

Seat of office

Name participant

Participation number(s)

Allianz Nederland Levensverzekering N.V.

Investment check

Allianz Pension Investing

Why an investment check?

With an investment check you determine your personal risk profile. Your risk

profile indicates which investment option suits you best. Based on your personal

risk profile, Allianz examines each year whether it corresponds with the risk that

you actually run on your investments. We are thus able to warn you if the risk on

your investments does not match your personal risk profile.

Notify or change investment choice

We invest for you on the basis of an average risk. You then invest in the neutral

lifecycle. On your member certificate, you can find out which options you have

within Allianz Pension Investing. If your employer has given you several choices,

you can notify or change your investment choice with this investment check.

If you would like to exercise more influence on your investments, you can, if your

employer provides this option, also choose Allianz Pension Self-Investment. In that

case, would you please complete and submit the fund selection form in addition

to this investment check. More information about self-investment can be found on

www.allianz.nl/pensioenbeleggen.

Determination of risk profile

Answer the questions below by choosing one answer for each question. A number

of points are awarded for each answer. Add up all the points to determine your

total score.

Attitude towards risk

1. I am usually upset about the losses I incur.

a Totally disagree

b Disagree

c Neither agree nor disagree

d Agree

e Totally agree

2. In general, I want an investment with little or no fluctuation

(price changes) and I am willing to accept the associated lower returns.

a Totally disagree

b Disagree

c Neither agree nor disagree

d Agree

e Totally agree

3. I accept the greater likelihood of a decrease in the (accrued) capital sum if

I aim for a high return.

a Totally disagree

b Disagree

c Neither agree nor disagree

d Agree

e Totally agree

Knowledge and experience

4. Which of the following possibilities is best suited to your level of

knowledge with regard to investments and your financial-economic

working experience?

a No or little knowledge. No financial-economic working experience.

b Knowledge due to interest. No financial-economic working experience.

c Average knowledge. Financial-economic working experience.

d Above-average knowledge. No financial-economic working experience.

e Above-average knowledge. Financial-economic working experience.

I invest or have invested in the following financial instruments and trade or have

traded in:

5. Bonds or funds that invest in bonds

a Weekly

b Monthly

c Yearly

d Never

Investment Check Allianz Pension Investing

6. Guaranteed products

a Weekly

b Monthly

c Yearly

d Never

7. Shares and investment funds

a Weekly

b Monthly

c Yearly

d Never

8. Structured products and/or derivatives

a Weekly

b Monthly

c Yearly

d Never

Financial position

9. In the short term, my income will:

a Decrease strongly

b Decrease

c Remain stable

d Increase

e Increase strongly

10. How many years will premium still be paid before you retire?

a Regular payments during a period up to 10 years.

Optionally with voluntary additional investment.

a Regular payments during a period of between 10 and 20 years.

Optionally with voluntary additional investment.

a Regular payments during a period of more than 20 years.

Optionally with voluntary additional investment.

11. Which part of your free assets (possessions less debts, excluding your

house and mortgage) are you investing or are you planning to invest?

a Less than 10%

b Between 10% and 25%

c Between 25% and 50%

d More than 50%

Points from the questionnaire

To determine your risk profile, please add the points of the answers.

Determine your risk profile with the table below.

Question a b c d e

1 25 20 15 10 0

2 25 20 15 10 0

3 0 10 15 20 25

4 0 0 5 5 10

5 5 5 0 0 -

6 5 5 0 0 -

7 10 5 0 0 -

8 10 5 0 0 -

9 0 5 10 15 20

10 0 20 30 - -

11 10 5 0 - -

Total

Total points Risk profile

0-80 Defensive

81-135 Neutral

136-175 Offensive

Outcome of investment check

The outcome of my investment check is:

Please note! From your total score you can see what your risk profile is.

Risk profile total score

0-80 points Your risk profile is Defensive. You want to minimise the risk of a lower

capital sum. You thus accept that you have less chance of a higher capital sum

when investment results are good. In short: you choose to reduce your risks. The

Defensive Lifecycle fits you best in this case.

81 - 135 points Your risk profile is Neutral. You want to maintain a good chance of

a higher capital sum when investment results are good. In addition, you do not want

to run too much risk of a disappointing capital sum when price movements are less

favourable. You opt for the ideal mix of return and risk for your pension accrual. The

Neutral Lifecycle fits you best in this case.

136 - 175 points Your risk profile is Offensive. You want the maximum possible

capital sum and are prepared to take more risks for this. You are confident of a

good future price performance and accept a disappointing capital sum when price

movements are less favourable. The Offensive Lifecycle fits you best in this case.

Allianz Nederland Levensverzekering N.V.

Coolsingel 139, Postbus 761, 3000 AT Rotterdam

Telephone +31 (0)88 - 577 22 22, www.allianz.nl

AFM number 12000417, Chamber of Commerce registration number 30082982 300008-200

Investment choice

Indicate below how you want to invest. You can find your investment choices on

your member certificate. You can invest in accordance with the investment profile

that matches your risk profile. It is also possible to deviate from this. If you have a

neutral risk profile and do not want to deviate from this, you need only return the

investment check. We will then not change anything. If you have a defensive risk

profile, it is not permitted to choose the offensive lifecycle. However, it is possible

to choose the neutral lifecycle.

Important: If you choose a lifecycle that is different to the one associated with

your profile, we assume that you have sought expert advice from your advisor.

I choose to invest in the

Defensive lifecycle

Neutral lifecycle

Offensive lifecycle

In addition, if your employer has opted for this, you can choose a lifecycle that

contains active funds or a lifecycle with only passive funds. Do you want to know

what the difference is? In that case, see www.allianz.nl/pensioenbeleggen.

I choose to invest in

An active lifecycle

A passive lifecycle

I do not choose a lifecycle but will choose my funds myself. I know that the risk in

my investments is not automatically reduced.

Allianz Pension Self-Investment

Please note! Your employer may not have included the option of Allianz Pension

Self-Investment in your pension plan. On your member certificate you can read

whether Allianz Pension Self-Investment is possible for you. You can indicate your

choice of funds within Self-Investment with the fund selection form. You can find

this form on www.allianz.nl/pensioenbeleggen. Send the Allianz Pension Self-

Investment fund selection form together with this completed investment check to

Allianz.

Signature for approval

The undersigned requests Allianz Nederland Levensverzekering N.V. to change

the investment choice and hereby declares that he/she has obtained information

about the consequences that are or may be associated with this change. The

investment choice and the investment scheme of the participant referred to

must be changed. The undersigned declares to be aware that Allianz Nederland

Levensverzekering N.V., as a financial provider, does not provide advice and that

expert advice should be sought from a financial advisor who is involved with the

pension scheme.

Date

Seat of office

Signature

Send this completed investment check with the required signature to:

Allianz Nederland Levensverzekering N.V., Attn. Pensions department,

Antwoordnummer 5375, 3000 VB Rotterdam or scan this form and send it by

email to pensioenen@allianz.nl.

Delete Save Print